Michaelis G, Melzer C, Biscoping J, Hempelmann G
Klinik für Anaesthesie und Operative Intensivmedizin, St. Vincentius-Krankenhäuser Karlsruhe.
Anaesthesist. 1995 Jul;44(7):501-7. doi: 10.1007/s001010050183.
The use of autotransfusion devices is an established method of reducing the need for homologous transfusions in surgery [3, 11, 13], but technical factors still contraindicate the washing and concentration of blood volumes smaller than 300 ml. Therefore, haemoconcentration of small volumes of salvaged blood, as usually found in paediatric surgery, is considered to be a complicated and questionable practice [5]. Whereas these amounts of blood loss are easily tolerated by adults, they may necessitate homologous transfusions in paediatric surgery. In a prospective study, we investigated whether a simple technical modification in the processing of salvaged blood could facilitate the use of autotransfusion devices, especially in children. PATIENTS AND METHODS. Intraoperative blood salvage was performed in children 6 months to 10 years old undergoing surgery for hip dysplasia. Autotransfusion (Dideco STAT) was started when the blood loss was estimated to be more than 20% of the total blood volume (TBV). As a reference, we used a formula based on body weight [10]: for children up to the age of 6 years 80 ml/kg blood volume and for children up to 10 years 75 ml/kg. The total volume of salvaged fluid including blood, anticoagulant solution, and surgical irrigation was collected in a reservoir and transferred to the autotransfusion set, after which the reservoir was rinsed with 500 ml 0.9% saline solution in order to save the remaining blood. After processing, the blood was stored in the retransfusion bag. By adding the same volume of plasma expander (6% hydroxyethyl starch [HES], molecular weight 450,000), spontaneous sedimentation of the washed autologous erythrocytes (RBCs) for 10-15 min led to a concentrate of RBCs. After 10 mu filtration, the RBC suspension was retransfused (Figs. 1-3). RESULTS. Within 12 months, autotransfusion was performed during 6 out of 15 surgical procedures according to the method described above. The calculated blood loss averaged 25.6% of TBV, of which 21.4% (= 272 ml) could be processed by the autotransfusion device (Table 3). The mean values of 2.6 g/dl haemoglobin (Hb) and 6.8% haematocrit (HCt) in the salvaged blood increased to 9.4 g/dl and 27.3% in the processed RBC concentrates. After adding 6% HES solution, spontaneous sedimentation of the RBCs led to values of Hb 22.1 g/dl and HCt 59.8%. An average of 59.5 ml (22-99 ml) sedimented RBCs was retransfused to the patients, including 11.6 ml 6% HES solution (Table 4). In this manner, the need for homologous transfusions could be avoided in these patients both during and after surgery. CONCLUSIONS. This study shows that the use of blood salvaging in paediatric surgery is indicated under certain conditions. With the aid of the simple modification described above, we solved the main problem in paediatric autotransfusion by concentrating RBC suspensions with low Hb and Hct values after using the autotransfusion device.
使用自体输血装置是减少手术中同种异体输血需求的一种既定方法[3,11,13]，但技术因素仍然限制了对小于300 ml血容量的洗涤和浓缩。因此，小儿外科手术中常见的少量回收血液的血液浓缩被认为是一种复杂且有问题的做法[5]。虽然这些失血量成人很容易耐受，但在小儿外科手术中可能需要进行同种异体输血。在一项前瞻性研究中，我们调查了回收血液处理过程中的一项简单技术改进是否能促进自体输血装置的使用，尤其是在儿童中。患者与方法。对6个月至10岁接受髋关节发育不良手术的儿童进行术中血液回收。当估计失血量超过总血容量（TBV）的20%时开始自体输血（迪迪科STAT）。作为参考，我们使用了一个基于体重的公式[10]：6岁以下儿童血容量为80 ml/kg，10岁以下儿童为75 ml/kg。将包括血液、抗凝溶液和手术冲洗液在内的回收液体总量收集到一个储液器中，转移到自体输血装置中，之后用500 ml 0.9%生理盐水冲洗储液器以保存剩余血液。处理后，血液储存在回输袋中。通过加入相同体积的血浆扩容剂（6%羟乙基淀粉[HES]，分子量450,000），洗涤后的自体红细胞（RBC）自然沉降10 - 15分钟可得到红细胞浓缩液。经过10μm过滤后，将红细胞悬液回输（图1 - 3）。结果。在12个月内，按照上述方法在15例外科手术中的6例进行了自体输血。计算得出的平均失血量为TBV的25.6%，其中21.4%（= 272 ml）可通过自体输血装置处理（表3）。回收血液中血红蛋白（Hb）的平均值为2.6 g/dl，血细胞比容（HCt）为6.8%，在处理后的红细胞浓缩液中分别升至9.4 g/dl和27.3%。加入6% HES溶液后，红细胞自然沉降导致Hb值为22.1 g/dl，HCt值为59.8%。平均59.5 ml（22 - 99 ml）沉降的红细胞回输给患者，其中包括11.6 ml 6% HES溶液（表4）。通过这种方式，这些患者在手术期间和术后都可避免同种异体输血的需求。结论。本研究表明，在某些情况下小儿外科手术中使用血液回收是可行的。借助上述简单改进，我们通过在使用自体输血装置后浓缩低Hb和Hct值的红细胞悬液，解决了小儿自体输血中的主要问题。
